Juxta-articular nodules with transepidermal elimination in a patient with Raynaud’s phenomenon: the challenging differential diagnosis between rheumatoid nodule and granuloma annulare

Abstract

We report the case of a 51-year-old female who presented with firm, painful papules and nodules for 9 months, in the extensor proximal metacarpophalangeal and interphalangeal joints in both hands. She did not have a previous diagnosis of rheumatoid arthritis. She also denied arthralgia or arthritis. The patient had livedo reticularis and a history compatible with Raynaud’s phenomenon was reported. The histopathological exam showed well- developed confluent palisaded granulomas with homogenous eosinophilic necrobiosis, with signs of initial transepidermal elimination and no mucin. Thus, we are faced withthe challenging differential diagnosis of rheumatoid nodule preceding rheumatoid arthritis versus perforating juxta-articular granuloma annulare (pseudorheumatoid nodule).